In Practice: Doctors bury grief to help patients and families

Rebecca's cancer was born in her bone marrow. Her abnormal blood cells soon broke free of their nest, sailing down the rivers of her arteries and veins to seed her liver, lungs and brain with malignancy.

Chemotherapy for her metastatic acute myeloid leukemia had sapped Rebecca of her brunet curls and her youthful energy, but not her exuberant spirit. Every morning, as we approached her for morning rounds, she'd greet us with a broad smile, eager to show us the latest cards and notes she'd received from her fourth-grade classmates. Their good wishes were fervently shared not only by her family, wearied by their bedside vigils, but also by all of us caring for a little girl more likely to return to God's arms than to her classroom.

Rebecca's grim prognosis couldn't help but take its toll on the doctors and nurses working so hard to save her life. We labored to mask our sadness and worry from Rebecca and her parents as we offered medicines and hope. But rotations on the oncology ward were especially challenging for many of us residents who had chosen pediatrics as our specialty.

Medical lore tends to ascribe specific personalities to doctors who choose particular fields. Surgeons are the superheroes swooping in to save the day, while internists are methodical, analytical and diligent, the Sherlock Holmeses of medicine. Pediatricians are often seen as friendly and playful, able to connect with their young patients even as they serve as mentors for anxious and worried families.

I had decided to become a pediatrician because I wanted to serve patients in ways that would have a long-term positive impact — and working with children provided the opportunity to make a lifelong difference. It was hard to accept that all medicine could do for Rebecca was make her too-short life more comfortable.

Rebecca breathed her last breath quietly, with her devastated family by her side, a few days after I arrived in the unit. Her parents understandably could not prepare for the inevitable; they broke down sobbing, holding her hand and gently stroking her smooth forehead.

Like those of my fellow trainees, my own eyes filled with overflowing tears. We stood by in the hospital room, shaken and unsure of how to help Rebecca's parents — or ourselves. During medical school rotations in the internal medicine wards, we had glimpsed death beckoning to the elderly and consoled ourselves with the salve that those that passed on "had lived a good life." But Rebecca's life had only just begun.

I watched my attending physician, collected and calm, rest a gentle hand on the shoulders of the grieving parents and offer words of sympathy. I envied his composure, his ability to remain professional yet compassionate and supportive as the family mourned. Surely he must be feeling the sadness we all shared at the premature loss of this sweet young girl. And yet, in his field of pediatric oncology, how many such battles had he fought and lost? Could his years of fighting the good fight against cancer with high-risk patients have hardened his heart?

I was on call, so I left the family in his capable hands and resumed my duties for the rest of the evening, grateful that the wards were relatively quiet. Sleep was out of the question, however, and as midnight loomed, I found myself heading for the doctors' office at the end of the hall to catch up on my charting — and my thoughts.

Approaching the door, I saw that the light inside the small room was on. Then I spied the oncologist sitting alone at a desk, letting his tears flow. I moved to withdraw, but he saw me and waved me inside.

It never got any easier, he told me. Each child he couldn't save burned a scar on his heart. But, over the years, he'd learned that his job wasn't finished at the moment of loss — he had to remain stoic in his white coat and help the survivors come to grips with their loved one's death. Only after his work was truly done could the oncologist allow himself to be human and cry.

I've never forgotten lovely Rebecca and her family, though I do admit to being relieved when my oncology rotation ended and I returned to the kind of pediatric care that was more likely to provide a happy ending than the tears of tragic loss.

I've also never forgotten the oncologist's example, that, as a doctor, I should always embrace and treasure my own human-ness — but only after I had kept it under wraps long enough to effectively care for those who needed me first.

Yolanda Reid Chassiakos is director of the Klotz Student Health Center at Cal State Northridge and an assistant clinical professor of pediatrics at UCLA's David Geffen School of Medicine. As Linda Reid, she is the cowriter (with Dr. Deborah Shlian) of the medical thriller "Dead Air" and its sequel, "Devil Wind."

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